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General NPI Number Information
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NPI Number | 1639524598
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Entity Type | Organization
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Legal Business Name | VERDANT SENIORS PLACE LLC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 8207 W NICOLET AVE
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City | GLENDALE
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State | AZ
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Zip | 85303-1822
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Country | US
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Telephone | 602-818-6700
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Fax | 602-715-2257
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Provider Business Mailing Address
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Address Line | 8207 W NICOLET AVE
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City | GLENDALE
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State | AZ
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Zip | 85303-1822
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Country | US
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Telephone | 602-818-6700
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Fax | 602-715-2257
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. MA TERESITA PATINO ISIDERIO
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Credential |
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Telephone | 602-818-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AL9850H
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License Number State | AZ
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